Chapter 14 15 Part 3 Mental Illness and Treatment Part 3 Warning Do Not Try Treatment At Home The treatment of psychological disorders is tricky As with other types of illness even empirically supported treatments administered by trained professionals has a less than 100 success rate Who Can Be A Therapist Examples Clinical Psychologist At least a master s degree often a PhD or PSYD Psychiatrist MD or DO Social Worker MSW A nurse Practitioner MSN School Psychologist Med EdD PhD Clergy People Who Are NOT Licensed Therapists Your roommate who is a third year psychology major Your PSY 1010 instructor who has his masters in experimental neurology Dr Phil Because he lost his license for being unethical with a client Dr Laura Her doctorate is in physiology Therapy Settings Private Offices Schools Free Clinics In the home Hospitals Houses of worship Major Classifications Therapy is often portrayed as a dyad between a therapist and a client This can be the case but therapy can take place in a group setting and multiple clinicians can work together 1 Psychotherapy 2 Biological and medically based treatments Psychotherapy These tend to be psychologically based therapies that focus on the behavioral and cognitive aspects of psychological distress Behavioral and Cognitive Behavioral Therapies CBT is a family of therapies that use combinations of cognitive restricting and conditioning in order to treat psychological disorders Behavioral therapies focus more specifically on condition Systematic Desensitization Often used in the treatment of anxiety disorders especially phobias It requires on to build an anxiety hierarchy and exposing them to on step at a time Exposure may work by arousing anxiety and then allowing a fear response to be extinguished when nothing happens Example Anxiety Hierarchy Activity Job Interview Applying for Jobs Going to a Party Dinner party with friends Calling someone for the first time Returning a call Asking a question of a stranger Flooding Operant Condition Token Economies Fear Avoidance 10 9 8 6 6 3 2 0 9 7 3 4 4 4 Similar to Systemic Desensitization only people are exposed to the top of hierarchy right away and prevented from performing avoidant behaviors Particularly effective for OCD Token economies are reward systems where tokens that can be used to purchase something desirable are used to reward desired behaviors Used in schools institutional settings and at home Effective as part of behavioral treatment for autism and ADHD Aversion Therapy Cognitive Behavioral Therapies This form of therapy is an attempt to pair undesirable consequences with undesirable behaviors For Example Antabuse These therapies also have a behavioral treatment component but there is an additional focus on addressing the cognitive components of suffering Rational Emotive Behavioral Therapy Cognitive Therapy Mindfulness and Acceptance CBT Effectiveness Psychodynamic Therapies This form of therapy focuses on how negative irrational beliefs impair psychological functioning Psychologically unhealthy people awfulize REBT focuses on giving clients assignments that force them to rethink their negative assessments Developed by a depression researcher named Aaron Beck This emphasizes to an even greater extent challenging negative cognitions It is especially effective when treating depression Cognitive Restructuring Newer CBT treatments focusing on being mindful and accepting of thoughts feelings and experiences instead of trying to suppress them They are more effective than placebos and often in the case of depression as effective as medication In cases of anxiety they are more effective than some of the other approaches that will be mentioned next These are therapies that have grown out of the work of Freud They are more controversial than CBT but as effective for some disorders 1 Believes that distress often has roots in early childhood distress 2 They analyze the client s distressing thoughts wishes fantasies life patterns past events and the client therapist relationship 3 Believe clients need insight into unconscious processes allowing the cause of distress to become apparent Humanistic Approaches Nondirective Therapy Effectiveness of Therapy Biologically Based Treatments Psychiatry These are approaches to therapy that seek to help people overcome a sense of alienation and to become authentic There are strains of existential philosophy in Humanistic approaches The most famous humanistic approach is probably Nondirective Therapy developed by Cal Rogers The therapist shows nonjudgmental unconditional positive regard while clients determine the course of therapy Therapy is less than 100 effective Empirically supported therapies are better than no treatment but far from perfect Results are especially good concerning CBT as a treatment for anxiety but even then it only helps people manage anxiety instead of curing it Psychiatrists are medical doctors trained to treat mental disorders While some practice psychotherapy most manage medications The main form of psychiatric treatment is psychopharmacology This is the administration of medications to treat disorders There are several families of medications These are medications that target GABA serotonin and epinephrine receptors to alleviate anxiety symptoms These target dopamine epinephrine and serotonin receptor sites in order to alleviate depression symptoms Usually a Lithium salt called Lithium Carbonate Decreases norepinephrine and increases Psychopharmacology Antianxiety Medications Antidepressants Mood Stabilizers serotonin Anti psychotics symptoms Once again dopamine serotonin and norepinephrine are the targets Reduces psychotic How Can The Same Neurotransmitters Be Targeted By Different Drugs The same neurotransmitter can do different jobs in the brain depending on the structure of its binding site and the location of the binding site in the brain Also the areas involved in disorders sometimes overlap Antidepressants are effective for anxiety What Makes Psychiatry Hard Electroconvulsive Therapy Every person s biochemistry is a little different It takes time to find the right combination of medications for someone Also the drugs have side effects Patients may hate the side effects and a balance between side effects and efficacy may need to be stuck A patient receives electrical impulses to the brain which causes a seizure It seems to be an effective short term treatment for severe depression but effects often only last a few months